Children's uninsured rate fell during COVID-19

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The annual rate of uninsured children fell from 5.1% in 2019 to 4.1% in 2021, representing about 700,000 fewer uninsured children during the COVID-19 pandemic, according to new data released by the Urban Institute.

Data from the National Health Interview Survey indicates a corresponding 4.9% increase in public coverage during this time and a roughly corresponding decline in private coverage over the period, likely offsetting any potential increases to the uninsured rate that may have been brought about by job losses associated with the pandemic.

Separate data from the Current Population Survey shows similar results, though the changes in that survey are smaller and not statistically significant. But administrative data shows that about 4 million more children were enrolled in Medicaid/CHIP in March 2021 than in March 2019.

Administrative data indicates further gains in Medicaid/CHIP and Marketplace enrollment among children from early 2021 to early 2022.

Policies such as the continuous coverage provision in the Families First Coronavirus Response Act (FFCRA), which has prohibited states from disenrolling people from Medicaid during the COVID-19 public health emergency since March 2020, appear to have limited the pandemic's effects on children's coverage rates, UI found.

Enhanced Marketplace subsidies under the American Rescue Plan, passed in March 2021, as well as other economic recovery efforts, seem to have further protected children's insurance coverage. Together, these provisions may have even contributed to a decline in the uninsured by the end of 2021.

WHAT'S THE IMPACT?

The pandemic and its associated job losses threatened to reduce employer-sponsored health insurance coverage and increase uninsurance among American families. 

Though such risks were higher for adults because of the longstanding generosity of public coverage policies for children, the severity and novelty of the pandemic also had the potential to exacerbate children's coverage losses that had occurred between 2016 and 2019, and to jeopardize decades of progress in reducing their uninsurance rates.

The decline in children's uninsurance observed on the NHIS is remarkable given the economic downturn, and if it is confirmed by other federal surveys, policymakers will have a better understanding of which policies can successfully mitigate coverage losses during recessions, UI researchers contended. 

But without federal and state actions to maintain the enhanced Marketplace subsidies and limit coverage losses when the continuous coverage requirement expires, children's uninsurance could once again increase in 2022 and beyond.

The continuous coverage requirement will expire at the end of the public health emergency, which if not renewed again, will occur as early as the fall of 2022. After that, states will resume eligibility verifications, and because more than three-quarters of Medicaid/CHIP enrolled children are covered by Medicaid, most child enrollees will be affected, potentially threatening their coverage.

Nearly two-thirds of children who could lose Medicaid are likely eligible for CHIP or Marketplace subsidies, UI found.

Connecting children to other coverage sources and ensuring smooth hand-offs to the Marketplace will be critical and may be especially important in states with less generous Medicaid/CHIP eligibility policies, where children will be more likely to qualify for Marketplace coverage.

According to UI, states can also work to minimize unnecessary coverage losses among children who still qualify for Medicaid and CHIP by maximizing automatic renewals; maintaining sufficient workforce and consumer assistance capabilities; using up-to-date contact information, using multiple modes to reach families for needed information and following up with families as needed; and working with managed-care organizations, providers, navigators and community-based organizations to assist families as they renew coverage.

THE LARGER TREND

Without additional efforts to stabilize and even strengthen children's insurance coverage, uninsurance could once again increase later in 2022 or in 2023, the report found.

Additional opportunities to maintain or expand coverage include increasing enrollment and retention among Medicaid/CHIP-eligible children; adopting continuous Medicaid/CHIP eligibility policies for children to avoid coverage gaps; expanding Medicaid to parents in non-expansion states to further support family coverage; and fixing the "family glitch" to improve coverage affordability for families.

In June, insurer group AHIP came out in favor of a proposed rule from the Treasury Department and Internal Revenue Service to tweak the family glitch. The proposed rule would create a minimum value for family members of employees that can receive ACA tax credits. A recent Kaiser Family Foundation analysis found that about 5.1 million people fall into the ACA's family glitch, most of whom are enrolled in employer-based coverage but could pay lower premiums if allowed to buy subsidized marketplace coverage.

In the current scenario, the "glitch" is a provision that allows someone to get tax credits that lower premiums if their employer requires they spend more than 9.5% of their household income on premiums. But this threshold only applies to the patient's individual coverage, not the premium required to also cover dependents. A family wouldn't be able to receive assistance even if the person in question met the 9.5% benchmark.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com